Society and the science of COVID-19

The adjective “novel” was the first thing that struck most people about the early name given to the coronavirus that causes the disease we now call COVID-19. That word, in its common usage, is a synonym for “new.” But only a few were sure that that was all the scientists at the World Health Organization meant to convey. As things have turned out, apart from “corona,” referring to the crown-like spikes that adorn the virus, the term “novel” has become this virus’ defining characteristic.

To call it “novel” is a confession of the limits of science, a humbling recognition of the vastness and complexity of the microbial world it is attempting to chart. So new is this novel coronavirus that nearly five months after its first identification in Wuhan, China, a lot of things about its biology remain unknown.

Scientists have managed to map its genetic code, making it possible to design diagnostic tests to detect its presence in nasal swabs taken from infected hosts. But, other than that, scientists are still grappling with the complex ways it affects the human body.

Why it is fatal in some patients and benign in others remains a mystery. Why it sometimes tricks the immune system to go on overdrive and turn against the body, or how it is transmitted by people who have yet to show symptoms, or whether recovered patients develop enough antibodies to protect them against reinfection—these and many other questions continue to baffle scientists.

Without precise knowledge of its mode of action, it will take a while to develop a vaccine against this new coronavirus. The most hopeful estimate is anywhere between one and one-and-a-half years. The formulation of an effective cure for the disease itself is equally uncertain, even as a handful of drugs previously developed to combat similar viral diseases are currently being tried.

It is amazing to watch how the science of COVID-19 progresses by drawing from the anecdotal and documented observations of frontline medical professionals in countless emergency rooms and ICUs all over the world. As imperfect as it is, the knowledge derived from this face-to-face encounter with the virus has become the basic touchstone for the frantic daily efforts to save lives. This knowledge, culled from the frontlines of the battle against the disease, has also served as a wellspring of insights and hunches in the tedious quest for new vaccines and therapeutic drugs.

That, in crude summary, is where the science is at this point. It is daunting in its scale and urgency.

But, no less complex is the way the rest of society has reacted to the pandemic itself. This, too, begs to be analyzed and understood. Unprecedented restrictions on the conduct of everyday life have become the norm. These restrictions have put much of social activity on pause, producing a trail of adaptations and contingencies that can neither be easily predicted nor managed.

The recent clash between presidential adviser Joey Concepcion, who represents the voice of the business community in the Duterte administration, and the various medical societies led by the Philippine Medical Association on the use of the rapid antibody test (RAT) exemplifies the breakdown in communication that results from this public health catastrophe.

Concepcion is leading an initiative to hasten the reopening of business establishments while ensuring that a new wave of infections is not unleashed in the process. He is convinced that the key lies in the use of the RAT, which detects the presence of antibodies in people who have had mild infections or recovered from COVID-19. In this equation, the presence of antibodies signifies immunity.

The medical scientific community, however, did not share his enthusiasm for this type of screening as a guarantee of fitness to return to work. The quality of the available antibody tests in the market simply does not offer this kind of assurance. These tests cannot match the reliability of actual diagnostic procedures that are performed by trained clinicians. The doctors warned against the greater danger of a false sense of security arising from the unwarranted use of these antibody tests.

Unable to find confirmation from the medical community for his belief in the efficacious use of the RAT, Concepcion exploded with an undeserved rant against the medical community: “The problem with these doctors is that they do nothing but talk and complain. What’s going to happen here is that if the economy remains closed, so many will lose their livelihood.”

The doctors angrily excoriated him for his remarks. They told him the truth as they saw it: For the kind of uses the business community had in mind, these rapid antibody tests are not only a waste of money, they are also unnecessary. The WHO itself issued a scientific brief in April that said: “There is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an ‘immunity passport’ or ‘risk-free certificate.’”

The way I see it, Concepcion misunderstood the role of science in society. He expected doctors to tell him exactly what to do so business could confidently reopen. Science tells us what things are like in the world. It warns us against the dangers lurking out there and what might happen if we behaved in particular ways. But, science cannot tell us how to live, or, in Concepcion’s case, when and how to emerge from a lockdown.